MEDICARE: H2 REHABILITATION SERVICES OF KENTUCKY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		KY
2	261QR0400X	Rehabilitation Clinic/Center	100870	KY

General Provider Information

NPI Number	:	1457304123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	H2 REHABILITATION SERVICES OF KENTUCKY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 932184
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-4912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 MERIDIAN WAY STE 9
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2876
Country	:	US
Telephone Number	:	859-623-6334
Fax Number	:	859-623-6336

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	AMANDA STREETER
Credential	:
Telephone Number	:	800-699-9395

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/25/2024

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